PROJECT SUMMARY The candidate is an accomplished clinical researcher with formal training in epidemiological methods and a commitment to a career in clinical and translational research in the study of inflammatory bowel disease (IBD). The candidate's long-term career goal is to become an independently funded physician investigator, devoting more than 75% of his time to establish and maintain a clinical research program in IBD. The candidate's short- term career goals are to 1) further characterize the previously built large analytic IBD dataset by the candidate to include information on health-care and non-health care related expenditures; 2) produce the preliminary data and publications necessary for a successful R01 application. This application outlines the institutional commitment, research plan, and key mentors involved to ensure the candidate accomplishes these goals. Previously, the candidate's work has led to development of a truly novel, comprehensive nationwide registry of ulcerative colitis (UC) and Crohn's disease (CD) patients with linkage to various administrative databases. Leveraging and expanding this resource is the foundation for the current R03 application, which is a natural extension of the candidate's K23. Broader use of biologic agents that target tumor necrosis factor-alpha (TNF- a) has been associated with a significant rise in cost of health care delivery in UC and CD patients. Although a number of studies have estimated the cost effectiveness of biologics, the long-term impact of these medications on direct and indirect health-care costs particularly in UC is unknown. In this proposal, the candidate seeks to fill this knowledge gap through a comprehensive examination of impact of anti-TNF therapy on direct and indirect health-care costs, including rates of hospitalizations, surgery, work loss, and disability. The specific goals of the study are to 1) assess the impact of anti-TNF therapy on rates of UC-related hospitalizations and surgery; 2) estimate the societal costs of UC both pre- and post- the availability of anti- TNF. The research environment, which includes the MGH Crohn's and Colitis Center and MGH Clinical and Translational Epidemiology Unit will provide a rich, collaborative, and intellectually stimulating atmosphere to ensure the candidate's success. Through this award, the PI will expand his research into the economic analyses for high cost medical interventions, serving as a foundation for future R01 proposals based on comparative effectiveness studies in IBD.